Healthcare Provider Details

I. General information

NPI: 1083324875
Provider Name (Legal Business Name): DENISE CUELLAR COOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. DENISE STEFANIE CUELLAR ESPINO

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 E DESERT INN RD STE 200
LAS VEGAS NV
89109-2803
US

IV. Provider business mailing address

10141 DRIFTWOOD ESTATE ST
LAS VEGAS NV
89141-8789
US

V. Phone/Fax

Practice location:
  • Phone: 702-657-3873
  • Fax: 702-636-0787
Mailing address:
  • Phone: 714-322-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number862034
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: